Skin Allergies to Drugs

Cutaneous drug reactions are adverse responses to drugs that appear on the skin. A red itchy rash and hives are the most common reactions however there are many different types and some are life-threatening. Drugs that most frequently cause problems include sulfa drugs antibiotics such as penicillins and tetracyclines and phenytoin (a drug that prevents convulsions).

Signs and Symptoms

• Red itchy rash or blotches
• Hives
• Acne-like eruptions
• Pigmentation changes (may appear as brown or grey blotches)
• Dry cracked skin as in eczema
• Peeling skin
• Tissue death (necrosis)

What Causes It?

Some drugs that might cause cutaneous reactions include the following.

• Allopurinol (gout medication)
• Antibiotics (penicillins tetracyclines)
• Aspirin
• Barbiturates
• Chemotherapeutic agents (cancer treatments)
• Cortisones and other steroids
• Diuretics (water pills)
• Heavy metals (gold copper)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phenothiazines (antihistamines and sedatives)

What to Expect at Your Provider's Office

Your health care provider will examine your skin mouth and throat. He or she will ask you to list the drugs (prescription nonprescription and illegal) and herbal and vitamin supplements you've taken over the last four weeks. Your provider may have you stop taking the suspected drug and prescribe something else.

Treatment Options

Treatment Plan

Choice of treatment depends on the type of reaction you are having and how serious it is. Often symptoms disappear once you stop taking the suspected drug. However your health care provider may still need to prescribe drugs to stop the reaction. If you also have life-threatening symptoms such as trouble breathing you will be hospitalized until you are stable.

Drug Therapies

Prescription

• Corticosteroids—intravenously for severe reactions; topical ointment for skin sores
• Antihistamine—relieves itching
• Epinephrine—for severe reactions that involve the respiratory or cardiovascular systems

Over the Counter

• Topical ointments—relieve itching and foster healing

Complementary and Alternative Therapies

Mild to moderate reactions may be safely and effectively treated with alternative therapies.

Nutrition

• Vitamin C (1 000 mg three to four times per day) stabilizes certain types of skin cells and stops reactions.
• B complex with extra B₁₂ (1 000 mcg per day) aids in skin health.
• Vitamin E (400 to 800 IU per day) improves circulation to your skin.
• Zinc (30 to 50 mg per day) supports the immune system.
• Bromelain (125 to 250 mg two to three times per day) reduces inflammation.
• Magnesium (400 to 800 mg per day) may help prevent spasms in the bronchial passages.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

• Turmeric (Curcuma longa 100 mg two to three times per day)
• Quercetin (up to 1 000 mg three times per day)
• Hesperidin (200 mg three to four times per day)

An infusion of equal parts of coneflower (Echinacea augustifolia) yarrow (Achillea millefolium) chamomile (Matricaria recutita) peppermint (Mentha piperita) and red clover (Trifolium pratense) will strengthen your immune system reduce swelling and help with lymph drainage (fluid that is part of immune system).

To relieve itching use one or more of the following herbs brewed as a tea 1 tsp. of herb per cup of water: peppermint (Mentha piperata) chickweed (Stellaria media) or chamomile (Matricaria recutita). Be sure the tea is cool and apply to the affected area as needed. To help your skin heal add one or more of the following: marigold (Calendula officinalis) comfrey (Symphytum officinale) or coneflower (Echinacea angustifolia).

For open sores use powdered slippery elm (Ulmus fulva) goldenseal (Hydrastis canadensis) and marshmallow root (Althea officinale). Add enough skin wash to make a paste. Apply to affected area as needed.

Aloe vera gel applied to your skin can soothe burning and reduce swelling. For further skin relief add powdered oatmeal (or 1 cup of oatmeal in a sock) to a lukewarm bath. Or make a skin balm from flaxseed oil (2 tbsp.) plain or with 5 drops of oil of chamomile (Matricaria recutita) or marigold (Calendula officinalis).

Homeopathy

Some of the most common remedies used for cutaneous drug reactions are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Apis for acute swelling with burning pains that are relieved by cold applications
• Graphites for eczema or urticaria (hives) with tremendous itching
• Ledum for cellulitis or eczema with severe inflammation
• Rhus tox for burning and itching that are relieved by hot applications
• Urtica urens for burning and itching

Following Up

It is important to stay in touch with your health care provider until the reaction is completely cleared up. If you have severe reactions wear medical-alert jewelry stating what drugs you are allergic to.

Special Considerations

If you have any questions about any drug—whether it is prescribed by your health care provider or purchased over the counter—ask your pharmacist or health care provider.

Supporting Research

American Academy of Dermatology. Guidelines of care for cutaneous adverse drug reactions. J Am Acad Dermatol. 1996;35:458-461. Available at www.aad.org/guidelinecutaneousdrug.html.

Balch JF Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park NY: Avery Publishing Group; 1997.

Dambro MR ed. Griffith's 5 Minute Clinical Consult. Baltimore Md: Lippincott Williams & Wilkins; 1998.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicines. 2nd ed. Rocklin Calif: Prima Publishing; 1998.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.